Simplicity beyond complexity

Last week I advised a rather algorithmic SAQ approach of thinking of and writing relevant facts. Excellent candidates however are already writing and succinctly explaining relevant facts because they understand the material well enough to distil out what is important. Oliver Wendell Holmes coined the term ‘simplicity beyond complexity’ which is where you want to aim for – to understand the material well enough to know what’s important, sum it up and explain it. If you’ve not heard of Oliver Wendell Holmes before then read Letter to Dr Morton.

National Anaesthesia Day: Part 1

WTG_Morton

Today is a very significant one particularly if you are an anaesthetist.  On this day, 171 years ago, William Thomas Green Morton (pictured above) administered the first successful anaesthetic publically at what is now termed the ‘Ether Dome’ in Massachusetts General Hospital, Boston. I am biased but think this is the most significant medical discovery ever. What is perhaps surprising is that the demonstration didn’t happen many years earlier- ether is not a novel chemical nor is it difficult to synthesize. The analgesic and sedative properties of nitrous oxide had been known about for almost half a century but no one had bothered to apply this knowledge to the more expedient need of surgical anaesthesia. To be fair, Morton’s contemporary, Horace Wells, used nitrous oxide successfully for dental extractions before unfortunately ‘failing’ when he demonstrated it publically on the same stage as Morton would subsequently have success.  I put the ‘failing’ in apostrophes because although Wells’ patient (he was a medical student with a toothache) groaned when under the influence- eliciting the derisory, “Bah humbug!” comment from the surgeon- the patient later stated that he did not recall the procedure and that it had caused him no pain. Surgeons have forever since equated movement or vocalisation from the patient as evidence of inadequate anaesthesia.

Although we commemorate this event with the respect that it deserves, the pioneering anaesthetists of the day were not the most respectable or reputable bunch. For the most part they were greedy, self-serving dentists out to make a quick buck. Nonetheless we are indebted to them.

The following statements relate to October 16, National Anaesthesia Day:

It has always been celebrated on this date in Australia  TRUE/FALSE

Morton tried to patent ether calling his mystery drug ‘Letheon’  TRUE/FALSE

Morton was running late on the momentous day setting an unfortunate precedent  TRUE/FALSE

Morton was the first person to administer ether successfully for a surgical procedure  TRUE/FALSE

Morton killed himself by cutting his femoral artery at the age of 48 while imprisoned. He was incarcerated for throwing acid in a prostitute’s face  TRUE/FALSE

Answers another time. Happy Anaesthesia Day!

 

 

 

 

Australian Anaesthetic History- Part 2

Some answers for you. Again these mostly come from Dr Wilson’s “One Grand Chain”.

The first anaesthetic for a surgical procedure was given by William Ross Pugh in June, 1847 at Launceston.  This is probably true and the actual date was the 7th of June. The patient was a woman with a mandibular tumour. Seems this is a popular condition to have treated under historically significant anaesthetics- Morton anaesthetized Gilbert Abbott who also had a lump in his neck.  There is a statue of Pugh in Launceston that commemorates the event. There is reasonable evidence to suggest that Pugh wasn’t a properly qualified medical practitioner.

The first anaesthetic given in Australia was also by William Ross Pugh.   This is probably true. Pugh’s anaesthetics are the best documented but there are a couple of other contenders for the title. Of these a Sydney dentist named John Belisario has the best case to challenge Pugh. Interestingly both men gave anaesthetics on the 7th June, 1847!

The pioneering anaesthetists would have had to make their own ether.   This is true and it is not hard to do.

The first case of awareness under anaesthesia is also attributed to Pugh.  This is true regarding anaesthetics administered in Australia. Pugh anaesthetized three patients on 7th June (attempted to actually, the third case was a failure due to equipment issues). The second patient had a cataract removed and was aware but didn’t report it to be painful. The first case of anaesthetic awareness occurred with the iconic first ‘successful’ demonstration of ether by Morton on 16 October, 1846. The patient, Gilbert Abbott, later reported being aware of the procedure and that it was indeed painful. Presumably it would have been a lot worse if he’d had no ether at all!

The first reported anaesthetic death in Australia is also attributed to Pugh.  This is false. The first reported anaesthetic death was in April 1848. Like most ‘anaesthetic’ deaths there were several other contributing factors. The unfortunate patient was a middle aged woman named Ann Ryder who suffered two indignities on that fateful day: she was tossed from a carriage and sustained a compound fracture of the leg and she was also robbed. She was given ether and had her leg amputated. She briefly regained consciousness after the procedure but then became obtunded and was unable to be resuscitated. Pouring brandy down an obtunded person’s throat was a popular resuscitative measure at the time. It didn’t work in this instance.

Australian Anaesthetic History- Part 1

No LO for this stuff but pretty interesting nonetheless.  If you can’t be bothered to google the answers I will give them to you in a subsequent post.  I am pretty biased but I think Morton’s successful public demonstration of general anaesthesia using ether on 16th October 1846 is the single most important medical discovery of the modern era.  It is astonishing given the lack of social media and communication satellites in the 1840s that within months doctors were trying their hand at giving ether anaesthetics on the other side of the world including Australia.  Indeed the first anaesthetics in Australia were given in June 1847.  The apparatus used was based on a picture in a London newspaper published in January 1847.  It took four months to sail from London to Australia so it was only a matter of weeks from reading about Morton’s discovery that Australians were giving it a crack.  I don’t think many of us would try a novel technique on a patient that we’d only read about in a journal, especially when we needed to fashion our own apparatus!

The statements relate to historically significant events regarding anaesthetic practice in Australia. The definitive resource on Australian anaesthetic history is Gwen Wilson’s “One Grand Chain: The History of Anaesthesia in Australia”. Not a bad read. I got my copy gratis from the nice folk at the College library.

The first anaesthetic for a surgical procedure was given by William Ross Pugh in June, 1847 at Launceston.  TRUE/ FALSE

The first anaesthetic given in Australia was also by William Ross Pugh.  TRUE/ FALSE

The pioneering anaesthetists would have had to make their own ether.  TRUE/ FALSE

The first case of awareness under anaesthesia is also attributed to Pugh.  TRUE/ FALSE

The first reported anaesthetic death in Australia is also attributed to Pugh.  TRUE/ FALSE

 

 

 

 

Queen’s Birthday Special

It seems serendipitous that last week’s posts were obstetric related and today is the Queen’s Birthday holiday…

Queen Victoria was a relatively early adopter of anaesthesia and received chloroform anaesthesia for the birth of her 8th and 9th children, Leopold in 1853 and Beatrice in 1857. The chloroform was administered via an open drop technique, during the second stage of labour, with the aim of achieving semi-consciousness. The Queen is quoted as saying the chloroform was “soothing, quieting and delightful beyond measure”

 


It was James Simpson who, in 1847, first suggested the use of anaesthesia for labour. Initially obstetricians were almost universally opposed to the use of anaesthesia for labour, citing it as unnecessary for a natural process and concerned for the safety aspects.

John Snow, who anaesthetised Queen Victoria on both occasions, was a physician with a career spanning interest in anaesthesia. He experimented widely, on animals, using different inhaled substances in an attempt to find superior anaesthetic agents. He realised that the volatility of an agent declined as it was vaporised , due to the drop in temperature. Consequently he developed and early vaporiser, with a brass chamber which was immersed in water, to minimise temperature fluctuations. He appears to have been a man of great scientific rigour, which likely inspired confidence amongst the Queen’s physicians and eased the path for her to receive anaesthesia, when she and Prince Albert requested it. He was also a strong proponent of a doctor separate to the surgeon administering the anaesthetic. One of his major works On Chloroform and Other Anaesthetics and their Administration was published following his death is 1858. If you click on the title it will take you to a copy of the book, with William Morton’s name handwritten across the top!

John Snow made another great contribution to medicine as an epidemiologist. He was a believer that cholera was transmitted by contaminated water, contrary to popular belief at the time. Following an outbreak in London in 1854, he conducted an extensive epidemiological investigation tracking the details of victims and non victims to identify where they sourced their water. He identified the likely source as a pump on Broad Street, Armed with his research, he went to town officials and convinced them to remove the pump handle, making it impossible to draw water from the pump. The outbreak stopped almost instantly! It wasn’t until 1883 that Vibrio cholerae was isolated by Robert Koch and the means of transmission confirmed.

John Snow died age 45. Just imagine what he might have contributed to our speciality ( and others) if he had lived a long life……

John_Snow